Spine Journal最新文献

{"title":"Normalizing spinal cord compression measures in degenerative cervical myelopathy.","authors":"Sandrine Bédard, Jan Valošek, Maryam Seif, Armin Curt, Simon Schading-Sassenhausen, Nikolai Pfender, Patrick Freund, Markus Hupp, Julien Cohen-Adad","doi":"10.1016/j.spinee.2025.03.012","DOIUrl":"10.1016/j.spinee.2025.03.012","url":null,"abstract":"<p><strong>Background context: </strong>Accurate and automatic MRI measurements are relevant for assessing spinal cord compression severity in degenerative cervical myelopathy (DCM) and guiding treatment. The widely-used maximum spinal cord compression (MSCC) index has limitations. Firstly, it normalizes the anteroposterior cord diameter by that above and below the compression but does not account for cord size variation along the superior-inferior axis, making MSCC sensitive to compression level. Secondly, cord shape varies across individuals, making MSCC sensitive to this variability. Thirdly, MSCC is typically calculated by an expert-rater from a single sagittal slice, which is time-consuming and prone to variability.</p><p><strong>Purpose: </strong>This study proposes a fully automatic pipeline to compute MSCC.</p><p><strong>Design: </strong>We developed a normalization strategy for traditional MSCC (anteroposterior diameter) using a healthy adults database (n = 203) to address cord anatomy variability across individuals and evaluated additional morphometrics (transverse diameter, area, eccentricity, and solidity).</p><p><strong>Patient sample: </strong>DCM patient cohort of n = 120.</p><p><strong>Outcome measures: </strong>Receiver operating characteristic (ROC) and area under the curve (AUC) were used as evaluation metrics.</p><p><strong>Methods: </strong>We validated the method in a mild DCM patient cohort against manually derived morphometrics and predicted the therapeutic decision (operative/conservative) using a stepwise binary logistic regression incorporating demographics and clinical scores.</p><p><strong>Results: </strong>The automatic and normalized MSCC measures correlated significantly with clinical scores and predicted the therapeutic decision more accurately than manual MSCC. Significant predictors included upper extremity sensory dysfunction, T2w hyperintensity, and the proposed MRI-based measures. The model achieved an area under the curve of 0.80 in receiver operating characteristic analysis.</p><p><strong>Conclusion: </strong>This study introduced an automatic method for computing normalized measures of cord compressions from MRIs, potentially improving therapeutic decisions in DCM patients. The method is open-source and available in Spinal Cord Toolbox v6.0 and above.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using deep learning to enhance reporting efficiency and accuracy in degenerative cervical spine MRI.","authors":"Aric Lee, Junran Wu, Changshuo Liu, Andrew Makmur, Yong Han Ting, Shannon Lee, Matthew Ding Zhou Chan, Desmond Shi Wei Lim, Vanessa Mei Hui Khoo, Jonathan Sng, Han Yang Ong, Amos Tan, Shuliang Ge, Faimee Erwan Muhamat Nor, Yi Ting Lim, Joey Chan Yiing Beh, Qai Ven Yap, Jiong Hao Tan, Naresh Kumar, Beng Chin Ooi, James Thomas Patrick Decourcy Hallinan","doi":"10.1016/j.spinee.2025.03.009","DOIUrl":"10.1016/j.spinee.2025.03.009","url":null,"abstract":"<p><strong>Background context: </strong>Cervical spine MRI is essential for evaluating degenerative cervical spondylosis (DCS) but is time-consuming to report and subject to interobserver variability. The integration of artificial intelligence in medical imaging offers potential solutions to enhance productivity and diagnostic consistency.</p><p><strong>Purpose: </strong>To assess whether a transformer-based deep learning model (DLM) can improve the efficiency and accuracy of radiologists in reporting DCS MRIs.</p><p><strong>Study design/setting: </strong>Retrospective study using external DCS MRIs from December 2015 to August 2018.</p><p><strong>Patient sample: </strong>The test dataset comprised 50 preoperative DCS MRIs (2,555 images) from 50 patients (mean age = 60 years ± SD 14; 13 women [26%]), excluding cases with instrumentation.</p><p><strong>Outcome measures: </strong>Primary outcomes were interpretation time and interobserver agreement (Gwet's kappa) among radiologists grading spinal canal and neural foramina stenosis with and without DLM-assistance.</p><p><strong>Methods: </strong>A transformer-based DLM was used to classify spinal canal (grades 0/1/2/3) and neural foramina (grades 0/1/2) stenosis at each disc level. Two experienced musculoskeletal radiologists (both with 12-years-of-experience) provided reference standard labels in consensus. Ten radiologists (0-7 years of experience) graded DCS MRIs with and without DLM-assistance, with a 1-month washout period between sessions to minimize recall bias. Interpretation time and interobserver agreement were assessed.</p><p><strong>Results: </strong>DLM-assistance significantly improved interpretation time by 69 to 308 s (p<.001), reducing mean time from 159-490 s (SD 27-649) to 90-182 s (SD 42-218). Radiology residents experienced the largest time savings. DLM-assistance improved interobserver agreement across all stenosis gradings compared to baseline. For dichotomous spinal canal grading, residents had the largest improvement in agreement (κ = 0.63 to 0.77, p<.001). Conversely, for dichotomous neural foramina grading, musculoskeletal radiologists had the largest improvement (κ=0.60 to 0.72, p<.001). Notably, independent DLM performance alone was equivalent or superior to all readers.</p><p><strong>Conclusions: </strong>The integration of a deep learning model into the radiological assessment of DCS MRI improved radiologists' interpretation time and interobserver agreement, regardless of experience level.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide use is associated with higher rates of pseudarthrosis and dysphagia in patients undergoing posterior cervical fusion.","authors":"Mitchell K Ng, Paul G Mastrokostas, Leonidas E Mastrokostas, Ameer Tabbaa, Matthew Johnson, Jad Bou Monsef, Afshin E Razi","doi":"10.1016/j.spinee.2025.03.023","DOIUrl":"10.1016/j.spinee.2025.03.023","url":null,"abstract":"<p><strong>Background context: </strong>Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown efficacy in managing glycemic control and obesity but its effects on surgical outcomes, particularly in posterior cervical fusion (PCF), are underexplored.</p><p><strong>Purpose: </strong>To evaluate the association between semaglutide use and postoperative complications, costs, and readmissions in patients undergoing PCF.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients undergoing PCF were queried from the PearlDiver Mariner database between 2010 and 2022.</p><p><strong>Outcome measures: </strong>Outcomes included medical and surgical complications, readmissions, emergency department visits, and associated costs within 90 days and 2 years postoperatively.</p><p><strong>Methods: </strong>Patients with an active semaglutide prescription were propensity score-matched in a 1:5 ratio to controls based on age, sex, Elixhauser Comorbidity Index, and other clinical variables. Statistical analyses included chi-square tests and logistic regression, with significance set at p<.003 after Bonferroni correction.</p><p><strong>Results: </strong>A total of 340 semaglutide users and 1,540 matched controls were included. Semaglutide use was associated with significantly higher odds of pseudoarthrosis at 2 years (OR 4.79, 95% CI 3.11-7.37; p<.001) and dysphagia (OR 2.12, 95% CI 1.46-3.03; p<.001). Hospital cost analyses revealed significant differences between groups. Same-day ($5,000 vs. $11,700; p<.001) and mean 90-day costs were significantly lower ($12,200 vs. $18,800; p<.001) in the semaglutide group. No differences were observed in emergency department visits or readmissions (p>.003 for all).</p><p><strong>Conclusions: </strong>Semaglutide use is associated with an increased risk of long-term complications, including pseudoarthrosis and dysphagia, as well as lower same-day and 90-day costs in patients undergoing PCF. These findings highlight the importance of careful perioperative management of semaglutide users to optimize outcomes while leveraging its purported benefits.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External performance of the spinal infection treatment evaluation (SITE) score and spinal instability spondylodiscitis score (SISS) in predicting operative intervention for de novo spinal infections.","authors":"Grace X Xiong, Rachel Huang, Rajkishen Narayanan, Teeto Ezeonu, Ecaterina Duscova, Steven Banko, Leah Prischak, Anu Senthil, Sam Alfonsi, Matt Clark, Barrett I Woods, Mark F Kurd, Jeff A Rihn, Ian D Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1016/j.spinee.2025.03.006","DOIUrl":"10.1016/j.spinee.2025.03.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;As the incidence of de novo spinal infections has risen with increasing global medical complexity and intravenous drug use, so has the uncertainty around standard of care and surgical decision making. Nonoperative management has increased in popularity albeit with frequent failure rates in up to one-third of patients. Although clinical decision making has largely been guided by clinician experience and institutional preference, two recent scoring system-the Spinal Instability Spondylodiscitis Score (SISS) and the Spinal Infection Treatment Evaluation score (SITE) provide a promising potential avenue towards evidence-based pathways.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of the current study was to compare external performance of the SITE and the SISS score in predicting operative decision making in patients with de novo spinal infections seen at a tertiary urban referral center, using real-world clinical decision making as a comparison. A secondary aim was to elucidate areas with low reliability or floor or ceiling effects as possible targets for score improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective external validation study utilizing consecutive cases from an academic tertiary referral center PATIENT SAMPLE: Adult patients undergoing treatment for spondylodiscitis or spinal epidural abscess OUTCOME MEASURES: Using the surgical intervention as the ground truth, the primary outcomes were performance metrics of the SITE and SISS score including receiver operating characteristic curves, specificity, sensitivity, and interrater reliability for both score and classification. Of note, the SITE score increases in severity with lower scores, whereas the SISS score increases in severity with higher scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A panel of three blinded raters scored the clinical data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two-hundred thirteen patients were included, of which 62% (144/213) underwent nonoperative medical management and 38% (80/213) underwent operative management. Mean SITE numerical scores were lower (more severe) in the operative group (5.63 vs. 7.45, p&lt;.001). The most frequent categorical group for the SITE score was \"severe\" in both the operative group (93%, 74/80, mean score 5.63) and the nonoperative group (68%, 90/133, mean score 7.45). The mean SISS score did not differ between operative and nonoperative groups (6.73 vs. 6.25, p=.2). ICC agreement was \"almost perfect\" for the SITE score (0.86, 95% CI 0.82-0.89) and \"substantial\" for the SISS score (0.68, 95% CI 0.56-0.76). Performance metrics for the SITE score were \"good\" (AUC 0.743, 95% CI 0.67-0.81), and for the SISS score were \"poor\" (AUC 0.557, 95% CI 0.47-0.64). ROC analysis for SITE identified a cutoff score of 6.5 to optimize sensitivity and specificity at 0.692 and 0.700, respectively. If using the established cutoff of 8 for \"severe\" infection as described in the original scoring system, the sensitivity wa","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating and managing type 2 odontoid fractures: an interrater reliability study assessing agreement among spine surgeons.","authors":"Sennay Ghenbot, Janse T Schermerhorn, Cody D Schlaff, Kristopher Hooten, Ross Puffer, Bradley Dengler, Alfred J Pisano, Scott C Wagner, Donald J Fredericks, Melvin D Helgeson","doi":"10.1016/j.spinee.2025.03.004","DOIUrl":"10.1016/j.spinee.2025.03.004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Consensus agreement exists regarding the management of Anderson and D'Alonzo type 1 and type 3, however management of type 2 odontoid fractures remains largely controversial. Though displaced type 2 odontoid fractures are generally considered operative, in the appropriate patient, the parameters that define \"displacement\" and their relation to fracture stability and outcomes, are poorly defined in the literature. Sagittal fracture displacement, sagittal fracture angulation, fracture comminution, and presence of local cervical deformity impact surgical decision-making, but the effect each characteristic has on clinical decisions has yet to be defined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Our goal in this study is to 2-fold: (1) define agreement among spine surgeons, as it relates to 5 type 2 odontoid parameters: presence of local cervical deformity, presence of fracture comminution, sagittal displacement &gt;5 mm, sagittal angulation &gt;11 degrees, and clinical management, (2) assess the impact each variable has on the likelihood of surgical indication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Radiographic analysis study of spine surgeons assessing odontoid fracture morphology and clinical management, using retrospectively collected imaging data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients 65 years or older, treated within the military health system, with type 2 odontoid fractures and CT imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Our outcome measures of interest in this study are (1) agreement among spine surgeons, as it relates to radiographic measurements, and (2) the relative impact, measured by odds ratio, that each radiographic parameter has on clinical decision making, METHODS: We queried the Military Health System (MHS) for all type 2 odontoid fractures, between 2016 and 2023, which resulted in 441 patients, of which 37 had viewable CT scans. Six spine surgeons, 3 orthopedic-trained spine surgeons and 3 neurosurgery-trained spine surgeons, reviewed 37 sagittal CT scans of acute type 2 odontoid fractures and recorded \"0' or \"1\" for the presence of local cervical deformity, presence of fracture comminution, sagittal displacement &gt;5 mm, sagittal angulation &gt;11 degrees and surgical (1) or nonsurgical management (0). We performed an interrater reliability analysis using Fleiss' kappa coefficient to assess agreement among raters and binary multivariate regression analysis to quantify the effect of each variable on eventual clinical management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among all spine surgeons, there was substantial agreement with sagittal angulation measurements (k=0.69, p&lt;.01), moderate agreement with sagittal displacement measurements (k=0.55, p&lt;.01 and comminution (k=0.40, p&lt;.01), and fair agreement regarding surgical decision-making (k=0.262, p&lt;.000001). Subspecialty subgroup analysis demonstrated slight agreement with operative management in, both, orthopedic-trained spine surgeons (k=0.10, p&gt;0.05)","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of non-osseous union of type II odontoid fractures-a multi-institutional cohort study.","authors":"Chady Omara, Anna B Lebouille-Veldman, Alexander G Yearley, Azra Gül, James Withers, Helen Karimi, Emma J Steinbuchel, Harshit Arora, John L Kilgallon, Benjamin R Johnston, Jakob V E Gerstl, James T Kryzanski, Rania A Mekary, Michael W Groff, Ron I Riesenburger, Jeroen G J Huybregts, Timothy R Smith, Jeffrey E Florman, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2025.03.013","DOIUrl":"10.1016/j.spinee.2025.03.013","url":null,"abstract":"<p><strong>Background context: </strong>The management of type II odontoid fractures in elderly patients presents significant clinical challenges. Surgical treatment may lead to operative complications, while conservative management may increase the risk of non-osseous union, potentially compromising fracture stability.</p><p><strong>Purpose: </strong>This study aims to evaluate the safety of non-osseous union subtypes in type II odontoid fractures following conservative treatment and to identify risk factors for unstable fractures.</p><p><strong>Study design: </strong>A multi-institutional retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 307 patients with acute type II odontoid fractures treated conservatively between 2005 and 2022 were included. The mean age was 76±17 years, with a median follow-up of 24 months (IQR 9-55 months).</p><p><strong>Outcome measures: </strong>Fracture healing and stability were assessed. Safety of each healing subtype was determined by the incidence of new neurological deficits post collar removal or the need for surgical fixation. Risk factors for unstable fractures were also determined.</p><p><strong>Methods: </strong>Fracture healing was classified as osseous union, fibrous nonunion, or unstable nonunion based on CT and dynamic X-rays at collar removal. Fracture stability was assessed using only dynamic X-rays, with unstable fractures demonstrating active displacement. Neurological outcomes and the necessity for surgical fixation in each group were compared. Multivariable logistic regression was used to analyze risk factors for fracture instability.</p><p><strong>Results: </strong>Unstable nonunion occurred in 25% of patients, while fibrous nonunion occurred in 48% after a median collar wear of 3.7 months (IQR 2.9-6.2 months). New neurological deficits after collar removal were seen in 6% of patients with unstable nonunions during follow-up, but in none of those with fibrous nonunions or osseous unions, even after subsequent trauma. Risk factors for unstable nonunion included male sex (OR 2.14; 95% CI: 1.02-4.49), osteoporosis/osteopenia (OR 2.50; 95% CI: 1.17-5.37), and baseline fracture displacement (OR 4.81; 95% CI: 2.35-9.86).</p><p><strong>Conclusions: </strong>Fibrous nonunion is a viable outcome in conservatively managed type II odontoid fractures, reducing the need for surgery or prolonged collar wear. Risk factors for unstable nonunion included male sex, osteoporosis/osteopenia, and baseline fracture displacement. Unstable nonunions may lead to new neurological deficits occurring after collar removal in a small percentage of cases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive outcomes following adult spinal deformity surgery: a prospective study with 12-month follow-up.","authors":"Tej D Azad, John F Burke, Anmol Warman, Justin K Scheer, Michael M Safaee, Terry Nguyen, Jaemin Kim, Marissa Fury, Justin Lee, Vedat Deviren, Christopher P Ames","doi":"10.1016/j.spinee.2025.03.010","DOIUrl":"10.1016/j.spinee.2025.03.010","url":null,"abstract":"<p><strong>Background context: </strong>A common concern is that the stress induced by adult spinal deformity (ASD) surgery may cause a postoperative decrease in cognitive function, especially in the elderly patients with some component of cognitive impairment. On the other hand, it is possible that ASD surgery could stabilize cognitive function by increasing activity and decreasing pain.</p><p><strong>Purpose: </strong>Here, we evaluate the effect of ASD surgery on cognitive outcome in a prospective study.</p><p><strong>Study design/setting: </strong>This is a prospective study of patients undergoing ASD surgery at a single institution over a five-year period.</p><p><strong>Patient sample: </strong>ASD patients treated with posterior spinal fusion of greater or equal to 7 vertebral segments for adult deformity were included. Only patients with 12 month follow up are included in this study.</p><p><strong>Outcome measures: </strong>The primary outcome variable was performance on the Montreal Cognitive Assessment (MoCA) test of dementia and cognitive impairment, collected prospectively preoperatively and at 12-month follow-up. We also collected outcome metrics including the Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-22) with mental health (MH), activity (ACT), pain (P), and self-image (SI) sub-components. Preoperative and postoperative morphine equivalent dose (MED) of narcotic medication was collected using patient surveys and verified using prescription data.</p><p><strong>Methods: </strong>The primary outcome was assessed using a paired t-test. Further analyses included performing univariate and multivariable analyses comparing patients with improved versus nonimproved MoCA scores across demographic, radiographic, surgical, outcome data, and opioid usage.</p><p><strong>Results: </strong>We enrolled 55 patients who met inclusion criteria. There was a significant increase in MoCA scores at 12-month follow-up compared to preoperative MoCA scores (p<.001). Overall, 60% of patients exhibited an increase in MoCA scores, and 47.2% met minimally clinically important difference (MCID). More severely cognitively impaired patients tended to improve to a greater degree than less severely impaired patients (p=.003). While there was no clear association between reduction in postoperative opioid use and cognitive improvement, we observed a possible association between postoperative delirium and cognitive decline among patients with baseline cognitive impairment (p=.01).</p><p><strong>Conclusions: </strong>Our prospective data suggests that ASD surgery is associated with an improvement in cognitive function at one year follow-up. Further work is required to understand the drivers associated with cognitive improvement and worsening after ASD surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting quality of life of patients after treatment for spinal metastatic disease: development and internal evaluation.","authors":"Rene Harmen Kuijten, Bas Bindels, Olivier Groot, Eline Huele, Roxanne Gal, Mark Groot, Joanne van der Velden, Diyar Delawi, Joseph Schwab, Helena Verkooijen, Jorrit Jan Verlaan, Daniel Tobert, Joost Rutges","doi":"10.1016/j.spinee.2025.03.016","DOIUrl":"10.1016/j.spinee.2025.03.016","url":null,"abstract":"<p><strong>Background context: </strong>When treating spinal metastases in a palliative setting, maintaining or enhancing quality of life (QoL) is the primary therapeutic objective. Clinicians tailor their treatment strategy by weighing the QoL benefits against expected survival. To date, no available model exists that predicts QoL in patients after treatment for spinal metastases.</p><p><strong>Purpose: </strong>To develop and internally evaluate a model predicting QoL for patients after treatment for spinal metastases, across the spectrum of (local) treatment modalities.</p><p><strong>Study design/setting: </strong>Cohort study of prospectively collected data.</p><p><strong>Patient sample: </strong>Patients with spinal metastases referred to a single tertiary referral center in the Netherlands between January 1^st, 2016, and December 31^st, 2021.</p><p><strong>Outcome measures: </strong>The primary outcome was achieving a minimal clinically important difference (MCID) on QoL using the EQ-5D-3L index score 3 months after the referral visit (at the outpatient clinic or emergency department).</p><p><strong>Methods: </strong>Five prediction models using machine learning were developed: random forest, stochastic gradient boosting, support vector machine, penalized logistic regression, and neural network. Performance was assessed using cross-validation during development and bootstrapping for internal evaluation with discrimination (area under the curve (AUC)), calibration, and decision curve analysis. This study was funded by the AOSpine under the Discovery & Innovation award (AOS-DIA-22-012-TUM). A total amount of CHF 40,000 ($45,000) was received.</p><p><strong>Results: </strong>In total, 953 patients were included in the study, of which 308 (32%) achieved the MCID at 3 months. Discrimination was fair and comparable between the models, but the random forest model outperformed the other models on calibration and was therefore chosen as the final model (AUC 0.78; confidence interval (CI): 0.71 to 0.85; calibration intercept: -0.06; CI: -0.31 to 0.25; calibration slope: 1.05; CI: 0.70 to 1.44), with the following predictors ranked by importance: baseline EQ-5D-3L index score, Karnofsky Performance Scale, primary tumor histology, opioid use, and presence of brain metastases.</p><p><strong>Conclusions: </strong>We developed and internally evaluated a random forest model that predicts clinically meaningful improvement of QoL 3 months after the baseline visit at the outpatient clinic for patients with spinal metastases. Future studies should externally evaluate the random forest model to confirm its robustness and generalizability in daily practice.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes after anterior versus posterior surgery for degenerative cervical myelopathy: a pooled analysis of individual patient data.","authors":"Alex B Bak, Mohammed Ali Alvi, Ali Moghaddamjou, Michael G Fehlings","doi":"10.1016/j.spinee.2025.03.027","DOIUrl":"10.1016/j.spinee.2025.03.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Uncertainty exists regarding the optimal surgical approach to treat patients with degenerative cervical myelopathy (DCM). This uncertainty is particularly marked for patients with mild DCM who may be more sensitive to different management techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the effect of surgical approach on one-year outcomes for DCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Individual patient data meta-analysis of 3 independent, prospective, multicentre clinical trials (ie, CSM-North America, CSM-International, CSM-Protect) that enrolled patients between 2005 and 2018 in academic hospitals, with 1 yr follow up. Statistical analysis was performed from September 13, 2023 to April 2, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;From a total of 1047 adult subjects with DCM, 980 met the eligibility criteria who were surgical candidates with symptomatic and radiologically-evidenced DCM with no prior cervical surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes measures: &lt;/strong&gt;The primary endpoint was change in 36-Item Short Form Health Survey Physical Component Summary score (SF36-PCS; minimum clinically important difference [MCID]=4) at 1 yr compared to preoperatively. Secondary endpoints were change in modified Japanese Orthopedic Association (mJOA; MCID=2) score, Neck Disability Index (NDI; MCID=15) score, SF36 Mental Component Summary (SF36-MCS; MCID=4) score, and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two comparison cohorts were created: i) anterior surgery and ii) posterior surgery. Mean differences (MD) of outcomes with 95% confidence intervals (CI) were estimated using one-stage covariate-adjusted hierarchical mixed-effects meta-analyses with study and treatment exposure as random effects. A priori subgroup analysis in mild DCM patients (mJOA=15-17) was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean patient age was 56.9 years (SD=11.4), with 38.7% that identified as female. 560 patients (57.1%) received anterior cervical decompressive surgery for DCM. Patients who had anterior decompressive surgery experienced greater improvements in quality of life and disability at 1 yr follow-up than those who underwent posterior decompressive surgery in SF36-PCS (MD=1.57 [95% CI 0.11-3.03], p=.0348) and NDI (MD=3.32 [95% CI 0.58-6.05], p=.017). Dysphagia was more likely after anterior surgery. Pseudoarthrosis and wound infections were more likely after posterior surgery. In a subgroup of patients with mild DCM, patients who underwent anterior decompressive surgery experienced even greater improvements in SF36-PCS (MD=5.45 [95% CI 1.73-9.18], p=.0042), NDI (MD=10.37 [95%CI 3.43-17.31], p=.0035), and mJOA (MD=0.95 [95% CI 0.12-1.77], p=.0238; MCID=1) than posterior surgery patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Anterior surgical decompression for DCM is associated with greater improvements in 1 yr patient-reported quality of life and disability than posterior surgical decompressi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel radiologic parameter for assessing decompression adequacy in anterior cervical decompression surgery: the V-line.","authors":"Dong-Ho Lee, Sung Tan Cho, Chang Ju Hwang, Jae Hwan Cho, Sehan Park, Jin Hwan Kim, Wongthawat Liawrungrueang","doi":"10.1016/j.spinee.2025.03.007","DOIUrl":"10.1016/j.spinee.2025.03.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Anterior cervical decompression surgeries, such as Vertebral Body Sliding Osteotomy (VBSO) and Anterior Cervical Corpectomy and Fusion (ACCF), serve as vital surgical options for managing cervical myelopathy. Despite their effectiveness, incomplete expansion of the spinal canal can occur in certain cases. However, many patients still experience positive clinical outcomes after these surgeries, suggesting that assessing outcomes based solely on the lesion's canal-occupying effect may be limited. In cases of anterior-based fusion surgery, changes in cervical alignment can occur postoperatively. Since traditional measures like the canal occupying ratio (COR) consider only the absolute size of the lesion, they may overlook improvements in clinical symptoms due to enhanced lordosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study introduces the V-line, a novel radiologic parameter, to universally evaluate decompression outcomes in these procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;This retrospective analysis encompassed 93 patients treated for cervical myelopathy due to ossification of the posterior longitudinal ligament through either VBSO (N=76) or ACCF (N=17) OUTCOME MEASURE: Radiological evaluations included C2-7 lordosis, segmental lordosis, and COR. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively, at 1-year postoperatively, and at the final follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The V-line, defined on a plain lateral radiograph in the neutral position, connects the lowest point on the posterior margin of the vertebral body immediately above the osteotomy site to the highest point on the posterior margin immediately below it. The V-line classification was \"V-line (-)\" if the postoperative pathologic lesion contacted the V-line and \"V-line (+)\" if it did not. Patients were categorized based on postoperative COR and the V-line assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The V-line (+) group achieved a higher final JOA score (15.3±1.91) and JOA recovery rate (62.16±32.22) compared to the V-line (-) group, which recorded a final JOA score (14.25±2.33, p=.037) and a JOA recovery rate (24.71±32.00, p&lt;.001). Additionally, postoperative C2-7 lordosis (18.05±9.59, p&lt;.001) and segmental lordosis (18.53±8.49, p=.008) in the V-line (+) group were significantly greater than in the V-line (-) group (10.68±8.38; 11.42±7.87). However, when comparing groups based on postoperative COR, significant differences were observed only in the JOA recovery rate, with no notable differences in final JOA score, C2-7 lordosis and segmental lordosis between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Since the V-line accounts for both the mass effect of the pathological lesion and cervical alignment, this parameter effectively reflects the reduced impact of spinal cord compression when cervical lordosis is restored, even with residual ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}